Haldol, Pneumonia, PD

[Rnfortuna]

Why on earth would any one consider giving Haldol to an elderly patient with Parkinson's disease admitted for Pneumonia???? Just because he/she is confused/agitated!!

[Karou]

Am I the only one getting the vibe that the OP possibly has a family member with PD who was given Haldol? This seems personal.

Safety is priority #1. When a patient is delirious and becoming a danger to themselves or others, something must be done, and done quickly to prevent harm. Haldol would not be preferred, but possibly necessary if alternatives have been tried without success.

[Tenebrae, BSN, RN]

According to the American Parkinson's disease Association, Haldol use should be avoided in eldery.

Do the risks outweigh the benefits?

Someone in delerium unmedicated, anxious, agitated, climbs out of bed and falls over the fractures their hip

True story and yes that patient had parkinsons

[nutella, MSN, RN]

If haldol is contraindicated in parkinson's pts, is there a recommended alternative? We get a lot of elderly pts (ortho floor) with fx hips that are in many stages of delirium and it can be very dangerous for them and for us. It would be nice to be able to suggest the appropriate med to the first year resident, with rationale.

There is a reason why you need to be a APRN or MD to prescribe medications...

In any way, I have seen plenty of patients with PD who are on a antipsychotic. In many cases it is seroquel because of the sedating effect. Before the atypical antipsychotics came out, haldol was the AP of choice for many patients as it was best known to many non psychiatrists and be given also IV. However, atypicals came out and are known to have less side effects but they have their own set of problems. Zyprexa is also very popular as it comes in a sublingual preparation and also a liquid for im injection.

Of course all antipsychotics can have side effects like dystonia and TD, which can be harder to monitor in patients who also have PD. Haldol and other antipsychotics can make the QT interval longer - for some patients this means contraindicated.

The elderly get confused and delirious easily with any hospital admission or illness and though non medication intervention is also used - we all know that in plenty of cases strictly behavioral intervention does not always help. Aggression/combativeness, agitation, and confusion does not only lead to a higher risk for falls - it also lead to injury of personnel and patient unwell feelings. Anxiety can be very high with delirium.

In end of life care we use haldol for terminal agitation for patient who are restless/agitated and do not react to ativan or can't have ativan. Haldol comes in a po liquid as well with 2 mg/ml and can be given sl in end of life care. Sometimes it does not help because it does not have as sedating properties like for example zyprexa and the MD prescribes that. This includes also PD patients.

It has been much more discussed lately to use non pharmacological intervention more in patients with dementia and delirium, and those measures should be in place as well, but antipsychotics have a place in the tx of delirium.

First year residents are learning and they need to learn to make their own decision. It is ok to suggest something but generally speaking the whole point of a teaching hospital is also for residents to figure those things out as they learn to be doctors.

[Been there,done that, ASN, RN]

What other interventions were tried first?

[elkpark]

What other interventions were tried first?

None, I hope. This isn't a "chemical restraint" scenario, in which we have an ethical obligation to attempt less restrictive/invasive interventions first. This is a dangerous acute medical condition in which an antipsychotic medication is the standard, first-line treatment. What "other interventions" do you attempt before giving someone with pneumonia antibiotics?

There are plenty of nonpharmacologic interventions that are helpful with delirium, but they are part of a comprehensive treatment approach that includes medication, not instead of medication.

[MelissaC71]

In certain circumstances low dose Haldol can help with respiratory distress. While I agree it should not be a first line drug choice for an elderly patient with Parkinsons, it can help ease symptoms of breathlessness and air hunger. I'm curious what dose of Haldol was prescribed. We tend to give 1-2 mg for this demographic and it's not to chemically restrain.

[ScrappytheCoco]

Would you rather have this patient get up and fall or end up mechanically restrained? Benefits outweigh risk here.

[Penelope_Pitstop, BSN, RN]

Am I the only one getting the vibe that the OP possibly has a family member with PD who was given Haldol? This seems personal.

That was the impression I got as well...

[mmc51264, BSN, MSN, RN]

My question was asked because we may get a pt in the middle of the night and there is not always an attending readily available. Less likely to have an APRN, It was more out o curiosity on my part because we do get so many off-service pts and an overwhelmed resident might appreciate a reminder. Not meant to be antagonistic.

[elkpark]

However, in my experience, if your elderly patient is a danger to himself/herself or to the caregivers, IM Haldol and Benadryl are often given in combination to get them to sleep so that the delirium goes away.

Antihistamines (like Benadryl) are deliriogenic, and recommended to be avoided in individuals with delirium.

[Been there,done that, ASN, RN]

None, I hope. This isn't a "chemical restraint" scenario, in which we have an ethical obligation to attempt less restrictive/invasive interventions first. This is a dangerous acute medical condition in which an antipsychotic medication is the standard, first-line treatment. What "other interventions" do you attempt before giving someone with pneumonia antibiotics?

There are plenty of nonpharmacologic interventions that are helpful with delirium, but they are part of a comprehensive treatment approach that includes medication, not instead of medication.

I was attempting to include all available interventions regarding the confusion, not the pneumonia.

[canigraduate]

Antihistamines (like Benadryl) are deliriogenic, and recommended to be avoided in individuals with delirium.

Did not know that! Maybe I'm remembering wrong. I know for sure I've given that combo to a couple of psych patients, along with Ativan.

I'll remember that in the future.